Access to Mental Healthcare Providers and Local Crime

Monday, June 24, 2019: 3:15 PM
Jefferson - Mezzanine Level (Marriott Wardman Park Hotel)

Presenter: Catherine Maclean

Discussant: Dhaval Dave

Recent mass violent attacks, particularly mass shootings, have been linked to mental illness. These events have highlighted the potential importance of addressing mental illness as a means to prevent crime and violence overall. More than half of all incarcerated persons meet diagnostic criteria for a mental illness, suggesting that policies targeting mental illness will have positive spillover effects to crime. Further, there are several theoretically-based mechanisms through which mental illness can plausibly affect crime, either by influencing the likelihood of victimization or of committing crime. Mentally ill individuals may be more likely to be victimized as they are viewed as ‘easy’ targets by offenders. Mental illnesses impose cognitive difficulties. These difficulties may impede employment opportunities, leading to economically-motivated crimes, and promote violence through impaired perceptions of interpersonal interactions. Due to established co-morbidities between mental illness and substance use disorders, for instance substances are often used to self-medicate, mental illness may indirectly increase crime through heightened aggression, reduced impulse control, and so forth associated with substance-induced intoxication and/or economic crimes to support use of substances.

While mental illnesses are disabling, there are numerous modalities of efficacious treatments available. For instance, office-based treatments such as counselling services and use of psychotropic medications. However, unmet need for mental healthcare treatment is very high. Over 50% of those afflicted with mental illness do not receive treatment and lack of access to providers is a commonly cited barrier by those how sought, but did not receive, care. Indeed, there are well-established shortages of mental healthcare providers in the U.S.

This study is the first to explore the effect of local access to mental healthcare providers on crime. We exploit county-level changes in the number of office-based physician (e.g., psychiatrists) and non-physician (e.g., psychologists) providers specializing in mental healthcare. Changes are generated by provider entrances to/exits from the healthcare market. We use county-level crime rate data provided by the Federal Bureau of Investigation’s Uniform Crime Reporting program and county-level data on the universe of office-based mental healthcare providers from the U.S. Census Bureau’s County Business Patterns (CBP) over the period 1998-2016, and estimate differences-in-differences (DD) models. We focus on access to office-based providers as these providers play an increasingly important role in delivering mental healthcare and office-based care is likely more acceptable to patients than many alternative modalities.

We examine crime rates overall and crime heterogeneity. We control for a range of county-level factors in our DD models and estimate dynamic models to study the evolution of treatment effects. Our results suggest that increased local access to office-based mental healthcare providers leads to a reduction in crime; effects are largest for violent crimes. We also study the effects of local access to care on completed suicides.

Our findings imply that the social benefits attributable to office-based mental healthcare are larger than previously estimated as they appear to reduce crime in addition to improving mental health. Compared to imprisonment, improving access to office-based mental healthcare treatment may represent a cost-effective way to reduce crime.